急性主动脉夹层体外循环期间应用50%氙气静态膨肺对炎性反应的影响

Effects of pulmonary static inflation with 50% Xenon during cardiopulmonary bypass on inflammatory response in acute aortic dissection patients undergoing emergency surgery

目的:急性主动脉夹层(AAD)手术围术期并发症发病率和病死率均明显高于其他心脏手术。炎症反应是影响主动脉夹层手术患者围术期结局的重要危险因素。本文研究急性夹层手术在体外循环(CPB)期间应用50%氙气静态膨肺,观察其对围术期炎性因子变化的影响情况。方法:选择发病14d以内的急性主动脉夹层并拟行急诊手术的患者100例,随机分为两组:对照组CPB期间用50%氧气静态膨肺,气道压力控制在5cm H_2O;氙气组CPB期间用50%氙气静态膨肺,气道压力控制在5cm H_2O(1cm H_2O=0.098k Pa)。记录患者围术期的一般临床指标,并于诱导后(T_0)、术后10min(T_1)、术后6h(T_2)和术后24h(T_3)抽取患者静脉血测定炎性因子,包括白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、前列环素I2(PGI_2)和血栓素B2(TXB_2)。结果:两组患者术前的一般临床指标、围术期血流动力学及血生化学指标差异无统计学意义。住院期间对照组死亡5例,氙气组死亡6例,二者之间差异无统计学意义;存活患者中气管切开患者对照组为3例,氙气组无气管切开患者;术后机械通气时间,对照组为16.5h(14.75,36),氙气组为21.25h(13.5,44.25),两者之间差异无统计学意义。IL-6(P值分别为0.000及0.000)、IL-10(P值分别为0.000及0.001)、TNFα(P值分别为0.012及0.025)、TXB_2(P值分别为0.000及0.001)时间效应及时间治疗交互作用明显。T0至T1阶段,氙气组IL-6,TNF-α及TXB_2分别下降了23.5%、9.1%及30.2%,对应值在对照组分别上升了10.8%、26.2%及26.4%;IL-10在氙气组上升了28%,在对照组下降了7.5%。

Objective： Patients with aortic dissection is at high risk of mortality and complication during perioperative period. This study evaluated the effect of pulmonary static inflation with 50% Xenon during cardiopulmonary bypass（ CPB） on inflammation in acute aortic dissection patients undergoing emergency surgery and investigated the possible mechanisms of Xenon. Methods： 100 patients presenting with acute aortic dissection（ onset≤14 days） were randomly assigned to two groups,control group（ n = 50） ： pulmonary static inflation with 50% O_2,Xenon group（ n = 50） ： pulmonary static inflation with 50% Xenon. The pressure of pulmonary static inflation was maintained at 5 cm H_2O in both group. Blood samples were obtained after anesthesia induction（ T0）,10min（ T_1）,6 h（ T_2） and 24h（ T_3） after surgery to measure inflammation cytokines,including interleukin-6（ IL-6） 、interleukin-10（ IL-10） 、tumor necrosis factor-α（ TNF-α） 、prostaglandin I_2（ PGI_2） 、thromboxane B_2（ TXB_2）. Results： There were no significant differences between the groups regarding patients＇ general clinical data. Mortality-adjusted postoperative mechanical ventilation duration、patients with tracheotomy and in-hospital mortality were not significant difference between two groups. There was significant effect of time and treatment-time interaction for IL-6（ P = 0. 000 and P = 0. 000,respectively）,IL-10（ P =0. 000 and P = 0. 001,respectively）,TNF-α（ P = 0. 012 and P = 0. 025,respectively） and TXB_2（ P = 0. 000 and P = 0. 001,respectively）. In first fraction,the value of IL-6,TNFα and TXB_2 decreased 23. 5%,9. 1% and 30. 2% respectively in Xenon group,but the concurrent value increased 10. 8%,26. 2% and 26. 4% respectively in control group. In first fraction,the value of IL-10 increased 28% in Xenon group and decreased 7. 5% in control group respectively. Conclusion： Pulmonary static inflation with 50% during CPB can alleviate postoperative inflammatory reaction.